Protecting Tomorrow: The Power of HPV Vaccine
This year on my birthday I got a pretty special gift (HPV Vaccine). As a birthday gift to my 30s I choose HPV vaccine as my gift. I waited for nonavalent vaccine ( Gardasil 9 ) as it was not available in India. The vaccine is safe, so it won’t hurt you if you’re older. The vaccine protects against nine different strains of HPV, so even if I have already be exposed to one, it could still protect me against others. And I will get another shot of HPV vaccine after 6 month.
Lets make things simple about HPV
HPV is human papilloma virus & it is the most important risk factor for cancer cervix/cervical intraepithelial neoplasia ( it’s not the single most cause but it is the most important risk factor.)
Other risk factors are :-
- early coitarche ( early age of first Intercourse <18yrs )
- early pregnancy (<20yrs)
- multiple partners
- male partner with multiple partners
- immunocompromised states: like HIV
- multiparty
- low socioeconomic status
- smoking
- oral contraceptive pills
- if any other premalignant conditions: like cin, vulva intraepithelial neoplasia, vaginal intraepithelial neoplasia.
keep this in mind it is not related to early Menarche (first menstrual period in a female adolescent) / late menopause (end of menstrualcycle 40s-50s)/ genetic / familial history.
What to understand first about HPV
HPV has subtypes & it is good to know about it because in market 3 types of vaccines are available. So you should know this what you are buying & from which you are get shot, if you are planning too or for your child. lets not hurry understand it first and then decide.
HPV subtypes
| low risk | high risk |
| HPV 6 & 11 | HPV 16, 18, 31, 33, 45, 52,58 |
| it can cause: genital warts-condyloma & recurrent laryngeal papilloma. | It has oncogenic potential. |
| In female it can cause | in males |
| cervical cancer | penile cancer |
| vulvar cancer | oral cancer |
| vaginal cancer | anal cancer |
| oral & anal cancer |
HPV 16 & 18 leads to 80% of ca cx & most common HPV leading to anogenital/ oropharyngeal ca is HPV 16.
lets see how HPV transmitted
- sexually transmitted through genital-genital Intercourse, oro-genital Intercourse, ano-genital-Intercourse
- HPV can also passed on by skin-to-skin contact.
- female in relationship with another female are also susceptible to developing ca cx & cin (cervical intraepithelial neoplasia)
- congenital HPV infection: seen in newborn to pregnant female with genital warts (transient infection)
HPV takes 10-30 years time interval to act upon the body.
HPV is not a new virus. But many people don’t know about it. Most people don’t even have any signs. HPV may go away on its own without causing any health problems, But if it persist it can lead to cancers.
Prevention
Yes it can be prevented.This is the only preventable cancer. It is the most common female genital tract cancer & 4th most common cancer of overall, breast cancer is still on top.( breast ca > colorectal ca > lung > ca cx )
This year 2024 the Cervical Health Awareness month ( January ) Theme is LEARN, PREVENT & SCREEN.
=> To prevent CIN/CANCER CERVIX two strategies are there :
- screening for cancer cervix
- HPV vaccine
All women with uterus & all transgender male with uterus should be screened for ca cx starting at the age of 21( consult your gynecologist ).
Lets talk about HPV vaccines, which are available in the market
Vaccine Valent Effective against Protect from Cervarix Bivalent (2v) HPV 16 , 18 cancer cervix (ca cx) Gardasil Quadrivalent (4v) HPV 6, 11, 16, 18 genital warts & ca cx Gardasil 9
(Available & most common used)Nonavalent (9v) HPV 6, 11, 16, 18, 32,
45, 52, 58Six cancers ( ca cx, vulvular ca, vaginal ca, oral ca, penile ca, anal ca. ) lets get it more: preparation, when to give, best time for HPV Vaccine, who to give:
- vaccine prepared from L1 capsid protein from virus like colonies which lacks DNA ( NON INFECTIOUS )
- it’s highly immunogenic: high level of type specific humoral antibodies leading to prevention of entry of HPV into epithelial cells.
- IDEALLY-These vaccine should be taken prior to sexual activity, its benefits will be higher when taken before sexual activity.
- History of prior sex act, or HPV positive test are not contraindications to vaccine.
- If female want to switch from her monovalent(2v) / quadravalent(4v) to nonavalent (9v); no need to restart the vaccine. They have to substitute it on same schedule .
- If due to any reason vaccine schedule is interrupted no need to start it again, just continue with the previous schedule when remembered.
- Vaccine contraindicated in pregnancy but pregnancy test is not recommended (If unknowingly vaccine is given no action is needed).
- Not to given to patient with allergy to yeast or with recent febrile illness.
- And if a female has completed 2v / 4v vaccine: should not repeat entire vaccination schedule with 9v.
- Safe during lactation.
Best time for vaccine for more efficacy: HPV vaccination is best recommended at ages 11–12 years.
Previously FDA recommended age group was 9 to 26. Later FDA extended its age for vaccination 27-45.
NEW UPDATED WHO SAGE ( STRATEGIC ADVISORY GROUP OF EXPERTS ON IMMUNIZATION )
RECOMMENDATION APRIL 2022
Age Doses 9-14 years 1 or 2 15-20 years 1 or 2 >= 21 years 2 doses (at the interval of six months) HIV+ 3 doses (at 0, 1 & 6 month intervals) WHO has updated its recommendations for the human papillomavirus (HPV) vaccine. Of particular note, the paper states that a single-dose schedule, referred to as an alternative, off-label single–dose schedule can provide a comparable efficacy and durability of protection to a two-dose regimen. The recommendation for alternative single-dose scheduling was initially made by WHO’s independent expert advisory group, SAGE in April 2022.
Myth to be bust about HPV Vaccine:
- vaccine is free: no its not. You have to pay from your pocket for cervirax (2v)- roughly around 1500/- to 2000/-, gardasil (4v)- 3000/- to 4000/- & gardasil 9 (9v)- 10000/- to 11000/-
- you cannot take HPV vaccine after you are sexually active; no, you can get a shot. The U.S. Food and Drug Administration approved on October 05, 2018 supplemental application for Gardasil 9 (Human Papillomavirus (HPV) 9-valent Vaccine, Recombinant) expanding the approved use of the vaccine to include women and men aged 27 through 45 years.
- Hpv vaccine can be given to a child of sexual abuse if the child is <9 years : no absolutely not. Under no circumstances this vaccine be given below 9 years of age.
Most common side effects of HPV vaccine
- Syncope.
- Pain at the site of injection.
- Mild fever.
- Indurated lesion at the site of injection.
Things you can do to lower the Risk
- You can choose abstinence.
- You can limit the number of partners you have.
- Practice safe sex and maintain good hygiene ( But areas not covered by a condom can be exposed to the virus.)
- Choose a partner who has or had no or few sex partners.
Is there a cure for HPV ?
No there is NO cure for the virus (HPV) itself. There are treatments or called symptomatic treatments available for the health problems that HPV can cause like genital warts, cervical changes, and cervical cancer.
For further more details
Enjoy life while have it in control.
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